[目的]观察中低度近视儿童佩戴角膜塑形镜配合针刺疗法防治中低度近视的疗效.[方法]将60例中低度近视患儿随机分为对照组和观察组,每组各30例.对照组单纯给予佩戴角膜塑形镜治疗,观察组在佩戴角膜塑形镜的同时配合针刺治疗,疗程为1个月,并进行为期2年的随访.观察2组患儿在治疗1个月、3个月、6个月、1年和2年后的屈光度增加量和眼轴长度变化量,并评价2组患儿治疗2年后的临床疗效.[结果](1)治疗2年后,2组患儿的裸视力均有不同程度的提高,其中,观察组的总有效率为90.0％(27/30),对照组为76.7％(23/30),组间比较,观察组的疗效明显优于对照组,差异有统计学意义(P<0.05).(2)与单纯佩戴角膜塑形镜治疗的对照组比较,配合针刺治疗的观察组患儿在治疗1年和2年后的屈光度增加量、眼轴长度变化量均有明显减缓趋势,差异均有统计学意义(P<0.05);而2组患儿在治疗1个月、3个月、6个月后的屈光度增加量、眼轴长度变化量比较,差异均无统计学意义(P>0.05).[结论]在佩戴角膜塑形镜的同时配合针刺治疗,对防治儿童中低度近视有较好的远期疗效.

There are some techniques for disassembly of hard nuclear. It is challenging in hard cataract surgery through microincision. The classic chop or prechop techniques often do not succeed,resulting in incomplete nuclear segmentation. The authors describe a new chop technique for removing hard nucleus cataracts in coaxial microincisional cataract surgery. We create a deep hole (drill) in the central nucleus with the phaco tip and divide the nucleus (prechop) with the Nagahara chopper and the modified capsulorhexis forceps inside the hole. The chopper and the modified capsulorhexis forceps are spread apart laterally after they approach at the center of the nucleus, to create a complete fracture across the entire nucleus. Since January 2022, we have completed 27 eyes of 25 patients with hard nucleus cataract using this technique. Complete segmentation of the hard nuclear into two hemispheres was implemented with this drill and prechop technique in all cases. The effective phaco time and ultrasound energy decreased. No intraoperative complication such as iris injury, anterior capsule tears, zonulysis, or posterior capsule rupture with vitreous loss occurred during surgery. This technique simplifies the previous prechop techniques especially for hard nucleus in microincisional cataract surgery. The technique is efficient, safe and simple.

AIM: To discuss the advantages of press-and-chop technique compared with Nagahara phaco-chop technique.METHORDS: Totally 70 patients(70 eyes)with age-related cataract were randomly divided into 2 groups, press-and-chop technique group(35 patients 35 eyes), phaco-chop technique group(35 patients 35 eyes). In all cases, surgery began with a clear corneal incision, capsulorhexis and hydrodissection. In the press-and-chop technique group, the superficial cortex and epinucleus were aspirated by the phaco tip, then press the center of the lens front surface with the phaco tip. The Nagahara chopper was set around the lens equator, then the phaco tip was driven into the nucleus from the main incision, pull the Nagahara chopper toward the phaco tip. The two instruments were then separated laterally to produce a complete fracture of the nucleus. In phaco-chop technique group, the phaco tip was buried in the center of the endonucleus. The Nagahara chopper was brought through the side-port incision and the equator of endonucleus was engaged by the chopper under the lower edge of the capsulorhexis and pulled toward the phaco tip. The 2 instruments were then separated laterally to produce a complete fracture of the nucleus. The U/S time, preoperative and postoperative corneal endothelial cell density, corneal endothelium loss rate, corneal edema at 1d, 7d, best corrected visual acuity before and after surgery were recorded.RESULTS: The U/S time of press-and-chop technique group was lower than phaco-chop technique group [12.76(8.76,16.76)s vs 22.87(18.36, 27.38)s, P<0.01]. The corneal endothelial cells density in press and chop technique group was higher than that in phaco-chop technique group 1mo after operation(2133.44±348.58/mm2 vs 1957.94±280.54/mm2, P<0.05), and the variation rate of corneal endothelial cells in press-and-chop technique group was lower than that in phaco-chop technique group 1mo after surgery [0.15(0.08,0.22)vs 0.22(0.16, 0.28), P<0.01]. The corneal edema in press-and-chop technique group was lighter than that in phaco-chop technique group on the first day after surgery(Z=13.195, P=0.004), and corneal edema in both groups subsided on the 7d after surgery. There was no significant difference between two groups in BCVA on the first day after surgery(Z=-0.48, P=0.63).CONCLUSION: Compared with Nagahara phaco-chop technique, press-and-chop technique is simple and safe with less complications.

目的 解读Scott第二受害者支持三级介入模式,为我国今后开发相关支持项目提供参考.方法 利用文献分析法进行阐释和比较.结合第二受害者自然恢复历程变化解读该模式内在规律,将现有支持干预项目进行对比,辨别这类研究之间的联系和差异,深入了解该模式的影响.结果 Scott第二受害者支持三级介入模式可加快第二受害者恢复历程,在实践中可较好地维护第二受害者支持项目运行.结论 该模式理论符合第二受害者创伤恢复规律,对第二受害者支持项目的开发具有一定指导作用,值得借鉴.

背景:目前压疮治疗外用敷料品种繁多,挑选一种使用方便、安全、有效的敷料,可有效提高压疮治愈率.目的:系统评价5种敷料治疗压疮的效果.方法:应用计算机检索Embase、PubMed、Elsevier、维普数据库、万方数据库、中国知网数据库中关于不同敷料治疗压疮的随机对照试验,检索时间从建库至2018年7月,检索关键词为“pressure sore、pressure ulcer、decubitus ulcer、bedsore、dressing、bandage、randomized clincal trails、压疮、压力性溃疡、压力性损伤、敷料、贴敷、绷带”.由2名研究人员分别进行文献筛选、资料提取及质量评价,用ADDIS 1.16.8软件进行网状Meta分析.结果 与结论:最终纳入24个随机对照试验,共1 201例患者,涉及水胶体敷料、泡沫敷料、水凝胶敷料、凡士林纱布、无菌纱布5种敷料.网状Meta分析结果显示,水胶体敷料、泡沫敷料治疗压疮的效果优于无菌纱布、凡士林纱布(P＜0.05),其余敷料两两比较治疗效果无差异(P＞0.05).根据排序概率表得知,5种敷料治疗压疮效果的排序依次为:水胶体敷料、泡沫敷料、水凝胶敷料、无菌纱布、凡士林纱布.结果 表明,水胶体敷料、泡沫敷料治疗压疮的效果优于其他敷料.

目的 了解国际第二受害者研究热点和发展趋势,为我国相关研究提供参考.方法 以Web of Science数据库为统计源,利用CiteSpaceV5.4软件对第二受害者研究文献进行可视化分析.结果 共纳入85篇文献,年发文量呈上升趋势.发表期刊共计60种,前3名分别为《BMJ》《Journal Of Patient Safety》及《BMJ OPEN》.美国发文量遥遥领先,占比高达57.65％(49篇).19位高产作者中以Wu、Kris、Maetin、Eva及Walter等发文量最多,各4篇;初步形成两个核心作者合作团队.研究对象以医生为主,研究热点集中在第二受害者综合征、机构支持、患者安全及安全文化等.结论 第二受害者成为近年来国际医疗安全管理研究的新方向.国内学者可围绕研究热点进一步推进,以保障患者安全和医务人员身心健康.

Background To investigate the safety and efficacy of scleral concave pool trabeculectomy (SCPT) combined phacoemulsification for eyes with coexisting cataract and primary open-angle glaucoma (POAG). Methods This was a retrospective, controlled, interventional pilot case series. Thirty patients (30 eyes) were diagnosed with coexisting cataract and POAG between May 2015 and April 2018. Fourteen eyes underwent SCPT combined phacoemulsification were set as the study group, and 16 eyes received conventional phacotrabeculectomy were set as the control group. All patients were followed up for at least 6 months. The preoperative to postoperative changes in IOP, glaucoma medication requirements, BCVA, blebs functions, and adverse events were recorded. Results The groups were matched for baseline age, BCVA, IOP and types of IOP-lowering medications (all P > 0.05). At 6-month visit, there were no significant difference between control and study group in the improvement of BCVA (0.22 ± 0.24 versus 0.18 ± 0.26, P = 0.718), reduction of IOP (− 11.21 ± 8.61 mmHg versus − 9.19 ± 9.18 mmHg, P = 0.540) and the number of eyes that needed IOP-lowering medications (2 versus 3, P = 0.743). At the last visit, the rate of forming functioning blebs was significantly different between the study and control groups, (92.9% versus 68.7% respectively, P = 0.007). In the study group, 5 eyes developed hypotony, and 1 eye showed limited choroidal detachment, whereas in the control group 1 eye developed malignant glaucoma. All adverse events were successfully managed. Conclusion The SCPT combined phacoemulsification seems to be a safe and effective alternative to conventional phacotrabeculectomy for patients with POAG and visually significant cataract in the short-term.

目的 从文献计量学角度分析中国知识资源总库(China national knowledge infrastructure,CNKI)刊载的有关动静脉内瘘的临床研究现状与发展趋势,为动静脉内瘘的研究提供参考.方法 检索CNKI数据库有关动静脉内瘘的研究文献,时间范围限定在2013年1月1日～2017年12月31日.使用Note Express软件对纳入的1462篇文献的发文时间、关键词、期刊、基金、机构及文献共引等统计分析,采用Excel表格进行绘图.结果 近5年的发文量逐年上升,对动静脉内瘘护理及并发症的研究为本领域的研究热点.《中国血液净化》杂志在该领域的研究名列首位.国家及地方政府对该研究给予了一定的支持.结论 动静脉内瘘的研究态势发展良好,发展空间较大.《中国血液净化》杂志对该研究成果的传播起到促进作用.希望国家及地方政府加大对动静脉内瘘研究的关注与支持.

目的 通过Meta分析明确肿瘤患者PICC置管相关静脉血栓形成的危险因素,为预防及降低肿瘤患者PICC置管相关静脉血栓形成提供参考依据.方法 在中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库、维普数据库、百度文库、PubMed、EMbase、Web of Science、Medline、Cochrane中进行文献检索,检索时间为开始收录时间起到2018年11月并进行文献质量评价,应用Stata 13.0对国内外有关肿瘤患者PICC置管相关静脉血栓形成危险因素的病例对照研究及队列研究进行Meta分析,用Egger线性回归法判定发表偏倚.结果 共纳入18篇文献,总病例6425例,病例组/暴露组825例,对照组/非病例组5600例.危险因素合并OR值分别为:年龄≥60岁2.560(95％CI:1.653～3.967)、超重或肥胖3.552(95％CI:2.103～5.998)、合并高血压2.041(95％CI:1.302～3.200)、合并糖尿病2.021(95％CI:1.695～2.409)、PICC置管史2.188(95％CI:1.204～3.976)、置管期间放疗4.308(95％CI:1.901～9.763)、活动量少4.559(95％CI:1.035～20.085)、感染2.748(95％CI:1.397～5.408)、肿瘤分期为 Ⅲ～Ⅳ期2.746(95％CI:1.643～4.589)、肿瘤转移4.023(95％CI:1.895～8.544).Egger线性回归法分析显示,活动量少、肿瘤转移、置管期间放疗存在一定发表偏倚.结论 年龄≥60岁、超重或肥胖、合并高血压、合并糖尿病、PICC置管史、感染、肿瘤分期为Ⅲ～Ⅳ期为肿瘤患者PICC置管相关静脉血栓形成的危险因素,活动量少、肿瘤转移、置管期间放疗作为肿瘤患者PICC置管相关静脉血栓的危险因素的证据尚不充分.应对肿瘤患者中存在的可改变危险因素进行早期干预,加强监测不可改变危险因素.

目的 探索我国地方性砷中毒研究领域的动态,分析发展变化和趋势,为未来地方性砷中毒的研究提供借鉴.方法 以中国期刊全文数据库(CJFD)、维普数据库(VIP)、中国生物医学文献光盘数据库(CBM disc)、万方资源数据库(WANFANG)为统计来源,时间限定为2008-2018年且主题词含“地方性砷中毒”及“地砷病”的文献.利用NOTEEXPRESS 2.0文献管理软件和EXCEL表格可视化分析纳入文献的发文期刊、基金分布、高频关键词和第一作者来源分布情况.结果 共检索出科研论文1 941篇,纳入302篇,发文量总体呈逐年下降趋势,期间有小幅波动;刊载文献数量最多的期刊为《中华地方病学杂志》,共发文50篇(16.56％);82篇(27.15％)文献受到国家自然科学基金的资助;发文排名前七位的机构中哈尔滨医科大学位居首位;“砷中毒”、“地方性砷中毒”、“砷”、“饮水”与“煤”等为高频关键词,研究热点集中于从免疫学与基因学的角度研究砷中毒疾病的免疫毒性机制、从病因学角度分析砷中毒病区人群体内砷蓄积和砷代谢的差异与变化特征.结论 近十年我国地方性砷中毒的文献逐年减少与疾病得到一定控制有关,国家及地方政府给予了一定的基金支持;应持续加强病区砷污染状况的监管,加强砷中毒疗法与药物研究,改善砷中毒病人的生命质量.

目的 运用德尔菲法构建艾滋病专科护士核心能力评价指标体系,为艾滋病专科护士的培养与发展提供参考标准.方法 通过文献回顾、理论分析、临床调研等方法初步构建艾滋病专科护士核心能力各级指标;采用德尔菲法对27名专家进行2轮咨询,完成指标筛选与修改、确定权重;将指标转化为自评量表,采取便利抽样法对40名艾滋病护理人员进行问卷调查.结果 通过2轮咨询,形成艾滋病专科护士核心能力评价指标体系,包括一级指标6项,二级指标19项,三级指标60项;2轮专家咨询的权威系数分别为0.895、0.886,有效应答率分别为100％、92.6％,第2轮一、二、三级指标专家意见协调系数分别为0.897、0.633、0.574 (P＜0.001);40名调查对象核心能力各维度得分3.32～4.23分.结论 艾滋病专科护士核心能力评价指标体系科学合理、内容全面,专业特色突出,可为艾滋病专科护士的核心能力评价提供参考;初步应用发现艾滋病护理人员核心能力普遍不高,提示应加强艾滋病护理人员核心能力的培养.

Objective To discuss the advantages of capsulorhexis-chop forceps assisted prechop(CCFP)technique compared with stop and conquer.Methods 46 patients (54 eyes) with age related cataract were randomly divided into 2 groups,CCFP were performed in group A including 23 patients (25 eyes),stop and conquer were performed in group B including 23 patients (29 eyes).The U/S time,operation time,preoperative and postoperative corneal endothelial cell density,corneal endothelial cell loss rate,intraoperative complications,postoperative (UCVA) at ld and corneal edema were reported.Results The U/S time and operation time were shorter in group A than group B.On the first day after surgery,corneal edema was less severe in group A than group B.There is no significant difference between two groups in UCVA on the first day after surgery.The average corneal endothelial cell density was higher in group A than group B,The average corneal endothelial cell loss rate was lower in group A than group B after 3 months.One eye in group A had posterior capsule rupture,2 eyes in group B.Conclusions CCFP technique is easy and safe to operate with less complications,the time of ultrasound and the operation time are shorter,the loss rate of corneal endothelial cells is lower compared with stop and conquer.

Objective:To study the therapeutic effect of modified Zhengrong decoction combined with acupuncture on paralytic strabismus. Methods:There were 90 patients with paralytic strabismus divided into 2 groups. There were 45 patients in the decoction group treated with Zhengrong decoction ,while there were 45 patients treated with self Zhengrong decoction combined acupuncture in the decoction+acupucture group. The total effective rate of paralytic strabismus treatment,normal eye movement recovery time,time of complete disappearance of diplopia,time of disappearance of compensatory head position,healing time,preoperative and post-administration synoptophore examination score,symptom score,differences in quality of life scores were compared between 2 groups. Results:Compared with the decoction group,decoction + acupuncture group showed high total effective rate(P<0.05);decoction + acupuncture group was less than decoction group on normal eye movement recovery time,time of complete disappearance of diplopia,time of disappearance of compensatory head position and healing time(P<0.05),while after treatment,decoction group + acupuncture group was higher than the decoction group on these scores(P<0.05). Conclusion:The therapeutic effect of Zhengrong decoction combined with acupuncture on paralytic strabismus is obvious ,and can effectively relieve clinical symptoms,promote the recovery of eyeball movement,reduce the course of treatment and improve the quality of life in patients.

目的：探讨多焦点人工晶体临床应用效果。方法：将老年性白内障患者58例（80眼），分为两组。观察组49眼，植入多焦点人工晶体；对照组31眼，植入单焦点人工晶体。所有病例行白内障超声乳化摘除联合人工晶体植入术，术后定期随访远、近视力，最佳远、近矫正视力、调节力等指标。结果：两组患者之间的远视力和矫正远视力比较，差异无统计学意义（ P＞0.05）。但观察组患者的裸眼近视力、矫正近视力及调节力等明显优于对照组。结论：多焦点人工晶体可为患者提供良好的远、近视力及调节力，功能优于单焦点人工晶体。

目的探讨曲安奈德治疗视网膜静脉阻塞黄斑水肿的疗效。方法视网膜静脉阻塞并黄斑水肿患者29例30眼,FFA确诊静脉阻塞类型,玻璃体腔注射去除赋形剂的曲安奈德0.05 mL,治疗前及治疗后第1、3、7天,查视力、眼压、前置镜及OCT,治疗后1周复查FFA。对视力再次下降患者复查OCT。结果治疗后30眼视力均有提高,黄斑视网膜厚度逐渐减小;治疗后黄斑水肿复发11例11眼,均为缺血型视网膜静脉阻塞,占所观察病例的36.7%;治疗后3～4周有3例3眼发生高眼压,占10.0%。结论曲安奈德能有效治疗非缺血型视网膜静脉阻塞合并黄斑水肿,缺血型视网膜静脉阻塞合并黄斑水肿易复发,部分病例发生高眼压。

Objective To observe the therapeutic effect of spleen-strengthening and dampness-elimination Chinese herbal medicine for treatment of central serous chorioretinopathy(CSC)in perioperative period of laser treatment.Methods Thirty CSC patients confirmed by optical coherence tomography(OCT)and fundus fluorescein angiography(FFA) were given laser treatment,and then were treated with spleen-strengthening and dampness-elimination Chinese herbal medicine for 4 weeks.Before and after treatment,the changes of visual acuity,retinal morphology and the height of detached retina were monitored.The cure rate,the results of FFA and indocyanine green angiography(ICGA),and the recurrence rate were also examined.Results The average visual acuity of 30 patients was 0.54±0.21 before treatment,and became 0.80 ± 0.19 after treatment,the difference being significant(P0.05).The results of OCT showed that macular serous detachment of retina was gradually relieved,and the detachment height was 543.39 ± 132.33 μm before treatment and them became 213.81 ± 22.62 μm after treatment,the difference being significant(P0.05).Twenty-one cases(accounting for 70%)were cured within 4 weeks,and 9(accounting for 30%)were cured over 4 weeks.The results of FFA showed the retinal pigment epithelium(RPE)leakage points disappeared,and choroidal hyperpermeability was improved shown by ICGA.Seven months after treatment,CSC recurred in only one case,accounting for 3.3%.Conclusion The application of spleen-strengthening and dampness-elimination Chinese herbal medicine is effective for the treatment of CSC in perioperative period of laser treatment.

目的探讨出院后延续护理干预对视网膜脱离患者康复的作用。方法将60例视网膜脱离的出院患者随机分为观察组和对照组各30例。对照组患者给予常规出院指导;观察组在此基础上于出院后实施电话随访,进行延续护理干预。结果两组患者对治疗的依从性、视网膜复位率及患者满意度比较差异存在统计学意义(均P<0.05)。观察组患者的依从性、视网膜复位率及患者满意度均高于对照组。结论出院后进行电话随访,实施延续护理干预能满足复杂性视网膜脱离术后出院患者的健康需求,有效地提高视网膜脱离术后患者的治疗依从性和视网膜复位率。

[目的]探讨心理护理在眼底联合造影[眼底荧光血管造影(FFA)/吲哚青绿血管造影(ICGA)]检查中的应用。[方法]将160例FFA/ICGA检查病人随机分为对照组和观察组,每组80例,对照组进行常规护理;观察组在常规护理基础上进行心理护理。比较两组病人FFA/ICGA检查中不良反应发生情况。[结果]观察组病人FFA/ICGA检查中发生不良反应7例(8.75%),对照组36例(45.00%),两组比较,差异有统计学意义(P<0.05)。[结论]对FFA/ICGA检查病人实施心理护理,可使病人身心处于松弛状态,减少不良反应的发生,从而使病人顺利配合完成检查。

AIM:To discuss the fundus angiography of central serous chorioretinopathy(CSC),including fundus fluorescein angiography(FFA),indocyanine green angiography(ICGA),and synchronous spectral domain optical coherence tomography(SDOCT) in order to investigate the pathogenesis of CSC.METHODS:Fifty-four cases with CSC in our hospital during June 2009 to October 2011 were checked by using Spectralis HRA-OCT.Patients'FFA,ICGA and synchronous SDOCT were analyzed and explained.RESULTS:FFA of 54 cases with CSC appeared retinal pigment epithelial(RPE)fluorescein leakage,ICGA appeared choroidal vascular abnormal in lesions and SDOCT appeared neuroepithelial serous detachment.Comparing FFA with SDOCT of 38 cases(70.4%),FFA appeared fluorescein leakage where ICGA was small pieces RPE detachment.CONCLUSION:CSC patients' disorder location can be diagnosed accurately by checking FFA,ICGA and synchronous SDOCT,which provides clinical data for CSC pathogenesis in order to better guide clinical treatment.

目的:评价冷超声乳化白内障摘除联合微切口推注式人工晶状体植入术的安全性和有效性。方法:60例60眼白内障患者,核硬度为Ⅱ～Ⅳ级,在表面麻醉下,用1.8mm角膜穿刺刀行11点及2点角膜缘切口,采用"CoolFlashMode"及双手微切口超声乳化技术摘除白内障,通过推注器植入Acri.smart36A或46S折叠式人工晶状体;对照组随机选择病例98例(112眼),采用常规超声乳化手术方法,植入Staar公司KN-X预装推注式人工晶状体。比较两组病例超声乳化时间与总体手术时间、切口反应分级、术后1d角膜透明度、术后1周视力与散光。结果:实验组60眼中,0级及Ⅰ级切口反应44眼,占73.3%,术后1d,角膜透明无水肿者56眼(93.3%);对照组112眼中,0级及Ⅰ级切口反应46眼,占41.1%,术后1d角膜透明无水肿者91眼(81.3%),两组差异有显著意义。实验组术后1周平均散光(-0.71±0.34)DC,与术前散光相比差异无统计学意义(P>0.05);对照组112眼术后1周平均散光(-0.89±0.44)DC,与术前散光相比差异有显著意义(χ2=0.437,P<0.05);实验组超声乳化时间平均(9.04±4.32)s,手术时间平均(11.2±3.27)min。对照组超声乳化时间平均(10.26±6.41)s,手术时间平均(7.88±4.35)min。两组超声乳化时间差异无显著意义;总体手术时间实验比对照组长,差异有显著意义(χ2=2.477,P<0.05)。结论:冷超声乳化白内障摘除配合微切口折叠推注式人工晶体植入手术对角膜及切口有较好的保护作用,不增加手术源性散光,具有良好的临床疗效及安全性。